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Sheffield My Plan and Whole Family

Assessment (FCAF):Education led

SECTION A

My PlanThis section should be completed for children and young people with Special Educational Needs or Disabilities who require provision to be made to support their needs. Where the assessment and plan is only in relation to wider family needs this section does not need to be completed though it may be relevant to do so, particularly in identifying needs of an individual child.

SECTION B

Whole Family Assessment (FCAF)This section should be completed for families where there is a need to assess and support wider family needs. Where the assessment and plan is only in relation to an individual child’s Special Educational Needs this section does not need to be completed though it is good practice to consider the whole family.

SECTION CSupport PlanThis is an annual plan that should be completed to detail individual support in place to meet needs for an individual or family.

Date of issue of first Assessment / PlanDate of issue of this version of Assessment / PlanVersion Number

Name and contact details of lead person completing this Assessment / Plan

Section A: Sheffield My PlanChild/Young Person’s Full Name

I like to be known as

Date of Birth

Gender

Address

Contact Number

Languages spoken

Current Education Provider

of 25Sheffield My Plan and Whole Family Assessment – Autumn 2018

PART 1: PARENT/CARERS AND INVOLVED SERVICES

Name of person with parental responsibility (1)Address (if different from child)

Contact numberEmailName of person with parental responsibility (2)Address (if different from child)

Contact numberEmailIs the young person in public care? (Y/N)

Service Officer, role and contact details (telephone and email)

Date of last provided advice/report

Education Provider

Educational Psychologist

Education Advisory Service (please detail)Social Care

MAST / Early Intervention

GP

Medical professional (please detail)Therapy Services (please detail)Preparation for Adulthood / Careers GuidanceOther


PART 2: CHILDNAME’S VIEWS / ONE PAGE PROFILE

This is me: Things I need help with:

What others like about me and what I like about myself:

What is important to me now: What are the best ways to help and support me?

What is important to me in the future – my hopes and dreams:


How I communicate

When I do this….. We think it means ….. People helping me should ….

How I’m doing in my learningAttainment/Level (YEAR)

Subject Autumn Spring SummerReadingWritingSpellingEnglishMathsAttendanceOther subjects

Copy of progress measures if appropriate:


PART 3: PARENT/CARERS VIEWS ON CHILDNAME

Our hopes and dreams for CHILDNAME’s future – Our Aspirations

CHILDNAME’s history and background

What does CHILDNAME like and what are they good at?

What’s not working for CHILDNAME? What they need help with

What is working and could be better in the following areas for CHILDNAME:

Tell us about What’s working well What could be better and do they need help with

Physical Health:Health and Wellbeing including areas such as sleep, medical needs and physical needsWhat they think of themselves:Personal Identity and self-worth, including managing emotions and behavioursSelf-Care skills:How they look after themselvesHow independent they are:Family and social life including how they spend their time in and out of the homeHow they get on with others:Friendship and family relationshipsEducation:What they’re like in


education and how they feel about itCommunication:How they communicate and what happens when they try to communicateWhat impact does CHILDNAME’s needs have on the family and the home?

What needs to change for CHILDNAME?

Think about CHILDNAME moving towards the next phase of life and education or adult life. What hopes do you have? Do you have any concerns?

Plan from age 2, Age 9 (Year 4), Age 14 (Year 9), Age 17 (Year 12)

Who else needs to be involved in discussions about support and progression to the next stage of life and education?


PART 4: EDUCATIONAL STRENGTHS AND NEEDS

Prime Special Educational NeedAdditional Special Educational Needs

Education Strengths and needs – Communication and Interaction

Strengths

Special Educational Needs

Support in place to meet this need

Sheffield Support Grid

1A Communication and Interaction – Speech and Language

Grid level (Need):

Grid level (Provision):

Date Assessed:

Moderated by:

1B Communication and Interaction – Social Communication

Grid level (Need):


Date Assessed:

Moderated by:

Education Strengths and needs – Cognition and Learning

Strengths




2A Cognition and Learning – Learning

Grid level (Need):


Date Assessed:

Moderated by:

2B Cognition and Learning – Specific Learning Difficulties

Grid level (Need):


Date Assessed:

Moderated by:

Education Strengths and needs – Social, Emotional and Mental Health


Strengths




3A – Social Emotional Mental Health – Emotional Regulation

Grid level (Need):


Date Assessed:

Moderated by:

3B – Social Emotional Mental Health – Mental Health

Grid level (Need):


Date Assessed:

Moderated by:

Education Strengths and needs – Physical and/or Sensory Needs, including Visual and Hearing ImpairmentsStrengths




4A Sensory/Physical – Visual Impairment

Grid level (Need):


Date Assessed:

Moderated by:

4B Sensory/Physical – Hearing Impairment

Grid level (Need):


Date Assessed:

Moderated by:

4C Sensory/Physical – Physical Impairment

Grid level (Need):


Date Assessed:

Moderated by:

4D Sensory/Physical - Medical

Grid level (Need):


Date Assessed:

Moderated by:

Developing Independence including preparing for adult lifeThis should include a focus on employment, independence, community participation


and healthStrengths

Needs


PART 5: HEALTH STRENGTHS AND NEEDSThis may be only relevant where an individual My Plan is needed

Medical Diagnosis

Strengths

Needs relating to SEN


Is a Health Care Plan in Place? Yes No

PART 6: CARE STRENGTHS AND NEEDSThis may be only relevant where an individual My Plan is needed

Strengths

Needs relating to SEN

Care Needs not related to SEN



Section B: Sheffield Whole Family Assessment (FCAF)

PART 7: FAMILY LIFE

Family Genogram

People who live in the family home

Type of home - Housing Association / Council tenant / Private rented / Owner occupied / Other (please specify)

Other significant family and friends


Describe a good day for your familyWhat’s Working Well? What Could Be Better and Why?

What is important to you as a family?

Please detail anything that has happened in the past that may have impacted on your family

Please detail anything related to housing, work and money for your family that may be relevantWhat’s Working Well? What Could Be Better and Why?

Please detail anything related to where you live, your social life and interaction with the community for your family that may be relevantWhat’s Working Well? What Could Be Better and Why?

Professionals view on life at home – completed by:What’s Working Well? What Could Be Better and Why?


PART 8: HOUSEHOLD AND FAMILY/FRIENDS PROFILEThis table can be copied should there be more relevant individuals that are discussed as part of the assessmentFAMILY ADDRESS:TELEPHONE NUMBER:Full Name

Other names (also known as)

Date of birth or estimated due dateGender

Ethnicity

First language – is an interpreter needed (Y/N)Name of Education, training or employment establishmentRegistered with a GP (Y/N)

Has a disability (Y/N)

Provides care for another family member (Y/N)Took part in assessment (Y/N)

Lives in the family home (Y/N). Include address if not in homeTelephone number


FAMILY ADDRESS:TELEPHONE NUMBER:Full Name

Other names (also known as)

Date of birth or estimated due dateGender

Ethnicity

First language – is an interpreter needed (Y/N)Name of Education, training or employment establishmentRegistered with a GP (Y/N)

Has a disability (Y/N)

Provides care for another family member (Y/N)Took part in assessment (Y/N)

Lives in the family home (Y/N). Include address if not in homeTelephone number


PART 9: SERVICES INVOLVED WITH THE FAMILY

Agency Worker Contact Details (phone and email)

Family Member being supported

Brief details of support provided

Involved in this assessment?


PART 10: ABOUT THE ADULT’S LIFEPlease repeat this part for other adults assessed under the FCAF

Full name (legal name)

Also known as

What is important for you?

Physical healthWhat’s Working Well? What Could Be Better and Why?

Mental health and emotional well-beingWhat’s Working Well? What Could Be Better and Why?

Life style and behavioursWhat’s Working Well? What Could Be Better and Why?

ParentingWhat’s Working Well? What Could Be Better and Why?

Professionals view on how well things are goingI agree / disagree with this self-assessment

What’s Working Well? What Could Be Better and Why?


PART 11: ABOUT THE CHILD’S LIFEPlease repeat this part for all children in the family. Where part 2 and 3 of the My Plan have been completed for a child this does not need to be completed.

Full name (legal name)

Also known as

What is important for you?

What are your hopes and dreams?

Health and well being including identityWhat’s Working Well? What Could Be Better and Why?

Education and learningWhat’s Working Well? What Could Be Better and Why?

Self-Care SkillsWhat’s Working Well? What Could Be Better and Why?

Family and Social LifeWhat’s Working Well? What Could Be Better and Why?

Professionals view on how well things are goingI agree / disagree with this self-assessment

What’s Working Well? What Could Be Better and Why?


PART 12: FCAF SUMMARYRisk Assessment

Any concerns regarding visits to the family home, whether visits should be conducted alone or with workers from other agencies:

Making a plan to Make a Difference

What are the family still worried about most? What is important to you and your family?

Summary of Practitioners Views of identified Needs

What are you worried about most? What help and support does the family need?

Family Action Plan

What actions need to be taken to support the family?


SUPPORT PLANTo be re-set each year and reviewed termly with annual outcomes.

Are the following in place?

PEP Child Protection Plan Child in Need PlanFCAF Care Act Assessment MyPlan/EHC Plan

Any other plans in place?Outcome for this year: 1

By the end of year ? CHILDNAME/FAMILY will be able to ….. so that …..

Steps to meet the outcome:

What Who How Often / DurationWhat is happening in education to achieve this?What is happening outside of education to achieve this?Using advice from:Progress measure (1-5)

1. No progress or deterioration 2. Limited Progress 3. Moderate Progress4. Significant Progress 5. AchievedTerm 1 Term 2 Term 3

Outcome for this year: 2

By the end of year ? CHILDNAME will be able to ….. so that …..


What Who How Often / DurationWhat is happening in education to achieve


this?What is happening outside of education to achieve this?Using advice from:Progress measure (1-5)


Outcome for this year: 3

By the end of year ? CHILDNAME will be able to ….. so that …..


What Who How Often / DurationWhat is happening in education to achieve this?What is happening outside of education to achieve this?Using advice from:Progress measure (1-5)


Progress Review Term 1Date: What’s working What’s not working / Barriers to achievementChild View

Parent View


School View

Practitioners Views (include who)What’s been achieved? What needs to change including any new steps or

outcomes and actions to be completed


Parent View

School View




Parent View

School View


Parental/Young Person consent to Share Information

We are committed to ensuring the safeguarding of your sensitive data. The information collected on this form will be securely stored.

Your information may be shared with services such as Sheffield Council, the NHS and other education providers who may have a direct involvement. This will only be done only where it is appropriate and necessary. It will be used for the assessment of you/your child as part of the Graduated Approach to meeting needs. This means it may be used for the assessment, issuing and maintenance of a SEN Support Plan, My Plan or EHC Plan. It will be used to support the assessment of needs by education, health and social care services and enable Sheffield City Council, education, health and care providers to deliver services and support to you and your family where it is needed. It will also be used as part of the moderation by education providers and the Council of the support available to children with special needs (there are strict security procedures governing this moderation activity applying to all staff involved, with no personal information further disclosed). The information may also be used for monitoring and auditing.

We will not give information about you to anyone outside of Sheffield City Council and the education provider without your consent. The only times we will share information without consent is if we are required to do so by law. This is where it is part of a statutory function, or if it is necessary for safeguarding children. Any sharing of information will be done strictly in accordance with the General Data Protection Regulation (GDPR) 2018.

We will share the minimum necessary information between people and organisations providing services that you, your child or family is using, or is likely to use. The personal information gathered will no longer be shared if a decision is made at a review that this plan should cease.Please indicate your consent by signing below:

Name Signature DateParent

Child/Young Person

If there is any information or advice that the education provider or Local Authority may gather during the assessment and planning process that you wish to remain confidential, please give details below.

Please see the school and council website for more information on how your information rights are respected and personal information is used appropriately and legally.


END PAGE AND APPENDICIES

When sharing this document any appendices should be included. This should include copies of reports gathered as part of the process from involved professionals


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